tbuckley/cabot-search huggingface dataset:
Abstract 15346: Outcomes of Conduction System Pacing in Patients With Cancer and Cardiomyopathy
Authors: Jamario R Skeete, Michael Dunleavy, Jian Chu, Parikshit S Sharma, Melanie Rosado, Tochi Okwuosa, Annabelle S Santos Volgman
Journal: Circulation (2022)

Introduction: Conduction System (His-Bundle, Left Bundle Branch) Pacing (CSP) for cardiac resynchronization therapy (CRT) provides more physiologic ventricular activation than right ventricular pacing. CSP has demonstrated improved outcomes in patients with cardiomyopathy. The effectiveness of CSP in patients with cancer or prior exposure to cardiotoxic agents is unknown. Methods: We retrospectively studied patients with cancer who underwent CSP for CRT from January 2018 to June 2021 at Rush University Medical Center. Changes in QRS duration, left ventricular ejection fraction (LVEF), B natriuretic peptide (BNP), and hospital admission rates pre- and post-initiating CSP were analyzed at baseline compared with one-year post CSP using student’s T-Tests. Results: Sixty-five patients with cancer underwent CSP, of which 11 had cardiomyopathy and underwent CSP for CRT. Five patients (45.5%) were female, 5 (45.5%) Caucasian, with mean age 71.2± 9.0 years. Non-Hodgkin Lymphoma (3 cases, 27.3%) was the most common cancer. Most (90.1%) patients had non-metastatic disease, 72.7% had prior chemotherapy, 54.5% were treated with cardiotoxic agents. Seven patients (63%) had a baseline left bundle branch block (LBBB). QRS duration shortened (122.3 ± 18.9 ms. vs. 153.7 ± 20.6 ms, p=0.003), LVEF increased (27.0 ± 6.2% vs. 39.0 ± 12.9 %, p=0.007), and BNP decreased (807.6 ± 1709.9 pg/ml vs. 591.4.0 ± 1079.4 pg/ml, p=0.78) (figure1). There was no change in heart failure hospitalizations (0.3 ± 0.48 admissions /person/year), at baseline vs. 1-year post-CSP. Conclusion: In this small population of patients with cancer and reduced LVEF with indications for CRT, CSP was associated with significant improvement in LVEF and QRS duration; and a non-significant decrease in BNP. The overall hospitalization rate was very low. Future studies in a larger population with a longer follow-up period are paramount to further assess this promising strategy.
Abstract 15091: Cardiac Ct-Guided Exclusion of Left Atrial Appendage Thrombus Prior to Electrical Cardioversion for Atrial Fibrillation
Authors: Melina Cahnbley, Jay Sengupta, Susan A Casey, Dawn R Witt, Joao Cavalcante, Justin Berger, David Caye, Tamara Langeberg
Journal: Circulation (2022)

Introduction: Transesophageal echo (TEE) is routinely used to exclude left atrial appendage (LAA) thrombus prior to direct current cardioversion (DCCV) for atrial fibrillation (AF). However, the COVID-19 pandemic accelerated the use of non-invasive modalities such as cardiac computed tomography (CCT) to avoid aerosolizing viral particles during intubation, such as with introduction of a TEE probe. CCT is not routinely used as a clinical strategy to exclude LAA thrombus prior to DCCV. Therefore, we sought to determine the feasibility of CCT-guided DCCV.Hypothesis: CCT-guided elective cardioversion for atrial arrhythmias is a feasible modality to rule out left atrial appendage thrombus. Methods: We identified patients at Abbott Northwestern Hospital who underwent CCT in lieu of or in addition to TEE within 24 hours of elective DCCV for AF or atrial flutter from March 2020 to February 2022. Thirty-day outcomes were collected including cerebrovascular accident (CVA), myocardial infarction, cardiovascular death, re-hospitalization, arrhythmia recurrence, and overall mortality. Delayed imaging, 90 seconds after arterial phase, was obtained to exclude LAA thrombus. Results: Thirty-two patients were included in our analysis, 10 (31%) were female. Ten (31%) presented with new-onset of AF. CCT did not identify LAA thrombus in any patient. Post-DCCV, the mean time to arrhythmia recurrence was 16.5 days (SD: 9.3). At 30 days, 11 (34%) had been re-hospitalized but mostly for elective procedures. There was no CVA or mortality reported at the 30-day follow-up. Conclusion: CCT-guided elective cardioversion for atrial arrhythmias was evaluated for feasibility in a small pilot. In patients who had no LAA thrombus on CCT and subsequently underwent cardioversion, there were no CCT-related complications, CVA, or deaths at 30 days. Many patients benefit from early DCCV rather than waiting with uninterrupted anticoagulation. CCT guidance is a feasible alternative to TEE but needs further prospective comparison to TEE and uninterrupted anticoagulation in this clinical setting.
Abstract 236: Clinician-reported Physiologic Monitoring Of Cardiopulmonary Resuscitation Quality During Pediatric In-hospital Cardiac Arrest: A Propensity-weighted Cohort Study
Authors: Martha Kienzle, Ryan W Morgan, Jessica Alvey, Ron Reeder, Robert A Berg, Vinay M Nadkarni, Alexis A Topjian, Javier J Lasa, Robert M Sutton
Journal: Circulation (2022)

Objectives: The primary objective was to investigate the association between clinician-reported use of end-tidal CO2 (ETCO2) or diastolic blood pressure (DBP) to monitor cardiopulmonary resuscitation (CPR) quality during pediatric in-hospital cardiac arrest (IHCA) and survival outcomes. The secondary objective was to investigate the change in use of ETCO2 or DBP monitoring over time. Design: A retrospective cohort study was performed in two cohorts: 1) Patients with an invasive airway in place at the time of arrest to evaluate ETCO2 use, and 2) patients with an arterial line in place at the time of arrest to evaluate DBP use. The primary exposure was clinician-reported use of ETCO2 and DBP in each respective cohort. The primary outcome was return of spontaneous circulation (ROSC). Propensity-weighted logistic regression evaluated the association between monitoring and outcomes. The proportions of patients with clinician-reported ETCO2 or DBP monitoring were examined per calendar year. Setting: Hospitals reporting to the American Heart Association’s Get With The Guidelines ® - Resuscitation registry. Patients: Children &lt;18 years of age with an index IHCA arrest lasting at least one minute who had an invasive airway or arterial line in place at the time of arrest. Interventions: None. Measurements and Main Results: Between 2007 and 2021, 9710 arrests met all inclusion and exclusion criteria: 6824 in the invasive airway cohort and 2886 in the arterial line cohort. Clinicians reported using ETCO2 to monitor CPR quality in 1333 (20%) arrests and DBP in 1042 (36%). Neither ETCO2 nor DBP monitoring was associated with ROSC. Among secondary outcomes, ETCO2 monitoring was associated with higher odds of return of circulation (ROC; ROSC plus extracorporeal CPR [ECPR] (aOR 1.21 [1.03, 1.42], p = 0.02) and 24-hour survival (aOR 1.16 [1.00, 1.34], p = 0.04). Clinician-reported use of both ETCO2 and DBP monitoring increased over time (p &lt; 0.001). Conclusions: Despite increasing clinician-reported use of physiologic monitoring during IHCA, neither ETCO2 nor DBP monitoring was associated with ROSC. Monitoring of ETCO2 was associated with ROC and 24-hour survival.
Abstract 15927: Decaaf II Sub-Analysis: Effect of Catheter Ablation on Qol in Patients With Persistent AF
Authors: Nour Chouman, Chan Ho Lim, Mario Mekhael, Charbel Noujaim, Abdel Hadi El Hajjar, Lilas Dagher, Nassir Marrouche
Journal: Circulation (2022)

Introduction: The 36-item short form health survey (SF-36) is a reliable and validated questionnaire able to assess patients’ overall health &amp; QOL post catheter ablation (CA). Objective: To evaluate the impact of CA on overall health &amp; QOL, in patients with persistent AF 12 months post ablation. Methods: In a population of 784 patients with persistent AF, the SF-36 questionnaire was measured at baseline (pre-ablation) and 12 months post-ablation. As per the RAND 36-Item health survey 1.0 scoring method: For each of the categories of the SF-36 (as listed in table 1), answers were scored from 0 to 100 (with higher scores reflecting better health and QOL). The average score was then calculated for each sub-category. Mann Whitney test was used to compare pre with post-ablation score results for each sub-category. Results were presented as mean ± SD. P value &lt; 0.05 was considered significant. Results: SF-36 measurement 12 months post-CA showed significantly improved results in all categories of SF-36 QOL assessment in comparison to baseline : Physical functioning ( 80 Vs 67 P&lt; 0.001 ), limitations due to physical health (76 Vs 52 P&lt; 0.001 ), limitations due to emotional problems ( 85 Vs 75 P&lt; 0.001 ), energy/fatigue ( 64 Vs 50 P&lt; 0.001 ), emotional well-being ( 78 Vs 72 P&lt; 0.001 ), social functioning ( 88 Vs 79 P&lt; 0.001 ), pain ( 82 Vs 78 P&lt; 0.001 ), and general health ( 69 Vs 59 P&lt; 0.001 ). (table 1.) Conclusion: Cather ablation significantly improved all categories of QOL in patients with persistent AF.
Abstract 15471: Neonatal Mesenchymal Stem Cells Rejuvenate Cardiac Myocardium by Regulating Macrophage Polarization Revealed by Single Cell Sequencing After Ischemia-Reperfusion Injury in Rats
Authors: Rachana Mishra, Riley M Boyd, Sudhish Sharma, Sunjay Kaushal
Journal: Circulation (2022)

Introduction: Stem cells are an emerging therapy for cardiovascular disease. The immune system is modulated by stem cell administration, therefore we sought to characterize the immune environment following stem cell administration. Hypothesis: Neonatal cardiac mesenchymal stem cells (nMSC) improved heart function through an acute sterile immune response characterized by the temporal and regional of macrophages. Methods: nMSC were isolated from healthy neonatal myocardium. Brown Norway rats underwent ischemia-reperfusion injury (IRI) by temporary ligation of left anterior descending artery for 45 minutes. Following closure of the chest cavity, neonatal mesenchymal stem cells (nMSCs), dead nMSCs (dnMSCs), or placebo was administered by intra-coronary injection. At day five heart was collected for single cell suspensions. CD45 positive selection was performed and fed into the Chromium Single Cell Gene Expression workflow (Pleasanton, CA). Single cell sequencing analysis was completed using the Seurat package on RStudio v1.3.1093 (Boston, MA). Echocardiography was completed on post-operative days 7 and 28 for rats not sacrificed for single cell sequencing. Results: Our results demonstrate that nMSC treatment after IRI injury can significantly recover left ventricular ejection fraction. Single-cell sequencing analysis of CD45+ cells identified multiple unique CD68+ clusters. Notably, macrophage cluster 2 primarily consisted of cells from the nMSC treated group, whereas the macrophage cluster 1 was primarily cells from the dnMSC and placebo groups. Gene ontology analysis of macrophage cluster 2 demonstrated that this cluster primarily consisted of macrophages strongly associated with various aspects of the activated immune response, including lymphocyte activation and cytokine production. Conversely, macrophage cluster 1 gene ontology analysis revealed a weaker immune response signature. Conclusions: nMSCs are a promising therapeutic candidate for the treatment of myocardial infarction. The mechanism of this therapy is likely related to macrophage activation that further enhances the immune response in the impacted and at-risk myocardium following IRI injury.
Abstract 15090: At-Risk Financial Status is Associated With Less Favorable Outcomes in Patients With Left Ventricular Assist Devices
Authors: Kevin A Honan, Anju Bhardwaj, Saliha Erdhem, Sachin Kumar, Min Ji Kwak, Elizabeth Mosele, Angelo Nascimbene, Manish K Patel, Ismael Salas De Armas, Sriram Nathan, Bindu Akkanti, Igor D Gregoric, Biswajit Kar
Journal: Circulation (2022)

Background: Few studies have investigated the impact of psychosocial determinants in patients with left ventricular assist devices (LVADs). Methods: We conducted a single-institution, retrospective review of patients hospitalized for index LVAD implant (January 2013 to July 2019). Patients underwent a comprehensive psychosocial evaluation conducted by certified clinical transplant social workers. Each evaluation included psychosocial determinants of health: Psychiatric illness, Compliance, Substance abuse, Family support, Level of understanding, Adequate housing/transportation, and financial status . Factors such as financial status carried their separate scoring grade (0-4 scale); patients scoring 0 were counted as ‘high-risk,’ while those scoring &gt;3 (adequate income) were low-risk (Table 1). Results: Of 330 patients, 211 had comprehensive psychosocial risk assessment, while the others had abbreviated assessments due to acuity. A total of 93 patients had eventual death after device implantation. Maximum follow-up was 3280 days. Financial status showed significant association with survival on univariate Cox-regression analysis. Those with inadequate finances had lower survival (P = .014; Figure 1). On multivariate Cox-regression analysis, the impact of financial status on survival decreased. Conclusions: Socioeconomic assessments of patients eligible for LVADs are important, and further analysis is needed to identify relationships between psychosocial determinants and outcomes. Identification of specific causal relationships that predict worse outcomes in this patient population will benefit the field.
Abstract 14437: Safety of Fluoroless Radiofrequency Ablation for Atrial Fibrillation in Patients With Pre-Existing Cardiac Implantable Electronic Device
Authors: Arshad Iqbal, Kai Yu Li, Sandeep Gautam
Journal: Circulation (2022)

Introduction: Radiofrequency catheter ablation (RFA) for atrial fibrillation (AF) is being increasingly performed without fluoroscopy. There is limited experience in flouroless RFA for AF in patients with pre-existing cardiac implantable electronic devices (CIED). Hypothesis: The safety of Fluoroless RFA for AF in patients with pre-existing CIED is uncertain. Methods: In this single-center study, we retrospectively evaluated patients undergoing fluoroless RFA for AF with pre-existing CIED in situ. A total of two hundred and sixty-four (264) consecutive fluoroless RFA procedures for AF from 6/1/2019 to 5/2/2022 were evaluated. All procedures were performed with intracardiac echocardiography (ICE) support. We assessed rates of CIED-related complications and changes in lead parameters over 30 days of follow-up. Pre and post-ablation device interrogations were reviewed for interval changes and compared for any change in the device or lead parameters. Patients were tracked for any subsequent device malfunction. Results: Among 264 fluoroless AF ablations patients, 25 (9.5%) had pre-existing CIED (13 dual-chamber pacemakers, 4 dual-chamber defibrillators, 4 single-chamber defibrillators/pacemakers, and 4 biventricular devices). Mean age was 71.2 ± 6.0 years with mean duration of indwelling CIED was 1821.1 ± 1586.8 days (see Table). Two (0.07%) patients had lead-related fibrin on ICE imaging. There was no significant difference in lead(s) threshold, impedance, or sensing post-procedure or at 30-days follow-up compared to pre-procedure (see Table). There were no intra- or post-op thromboembolic events or subsequent device infection over 30 days of follow-up. None of the patients required lead revision. One patient underwent CIED extraction after 11 months for an unrelated secondary device infection. Conclusion: Radiofrequency catheter ablation for AF can be safely performed without fluoroscopy in patients with CIED.
Abstract 231: Volume And Direction Of Carotid Blood Flow During Cardiopulmonary Resuscitation In A Porcine Model Of Ventricular Fibrillation
Authors: NORIHIRO NISHIOKA, Takeyuki Kiguchi, Yuto Makino, Francesca Fumagalli, Aurora Magliocca, Yasuaki Koyama, Tasuku Matsuyama, Wataru Kamo, tsuyoshi Kamada, Hideki Maeda, Giuseppe Ristagno, Taku Iwami
Journal: Circulation (2022)

Introduction: Hemodynamics during cardiopulmonary resuscitation (CPR) is not well understood. We aimed to quantitatively evaluate the volume and direction of carotid blood flow (CBF) during CPR in a porcine model of ventricular fibrillation (VF) cardiac arrest. Methods: Nineteen male domestic pigs were intubated and ventilated mechanically. Following baseline measurements, VF was electrically induced. CBF was measured continuously using a flow probe positioned around the common carotid arteries. After 0 or 5 min no-flow time of untreated VF, CPR was initiated, involving chest compressions and ventilation with oxygen. CPR was continued for 25 min, with mechanical (L1, L2, and L3) and manual (M1 and M2) CPR alternated at 5 min intervals. A Friedman test was used to compare the groups in each phase. Post hoc analysis was performed using a Wilcoxon signed-rank test (Bonferroni corrected). Results: CBF was calculated as the average of each phase. The net flow was calculated through subtracting the retrograde flow from the anterograde flow. Average net flow (median, interquartile range [IQR], mL/min) during CPR was 58.1 (24.0-111.3), 19.8 (8.4-24.9), 21.2 (9.5-37.9), 15.4 (8.4-24.9), and 16.4 (10.3-30.1) in phases L1, M1, L2, M2, and L3, respectively ( p &lt; 0.001, L1 vs. M1). The ratio (median, IQR, %) of retrograde to anterograde flow was 41.3 (16.7-58.7), 48.6 (33.1-60.4), 42.2 (36.5-76.4), 49.1 (39.4-68.5), and 50.0 (38.0-79.0) in phases L1, M1, L2, M2, and L3, respectively ( p = 0.299). Conclusions: In this VF cardiac arrest model, the net flow of the carotid artery during CPR decreased with time. Both mechanical and manual CPR produced substantial retrograde flow, although the ratio of retrograde to anterograde flow did not change.
Abstract 15052: A Young Patient Who Presented With Dilated Cardiomyopathy and Renal Infarction During Treatment With Isotretinoin
Authors: Gianluigi Napoli, Daniele De Feo, Maria Cristina Carella, Cinzia Forleo, Stefano Favale, Martino Pepe
Journal: Circulation (2022)

Background: Isotretinoin or 13-cis-retinoic acid (RA) is one of the most effective and widely used drug for the treatment of severe acne vulgaris. Despite deemed safe, no definite consensus has been reached on the cardiovascular risk of RA derivatives. We describe the first case of concomitant dilated cardiomyopathy (DCM) and renal infarction after 5 months of isotretinoin use in a previously healthy 18-years old man. Case Summary: An18-years-old man, with history of acne vulgaris, presented in August 2021 to our emergency department because of left iliac fossa pain and effort dyspnea. Computed tomography scan revealed left renal infarction and echocardiogram demonstrated global left ventricular (LV) dilatation with severely reduced LV-ejection fraction (LVEF: 29%). Coronary artery disease, autoimmune, infective, or heritable causes of DCM were ruled out. Cardiac magnetic resonance evidenced LV circumferential mid-wall late gadolinium enhancement and ECG monitoring revealed several non-sustained ventricular tachycardia episodes. Thus, Bisoprolol, Sacubitril/Valsartan, and Eplerenone were started and up titrated until maximum tolerated doses, with only poor LVEF improvement. Conclusion: Our case aims to raise awareness on rare life-threatening cardiovascular events associated with isotretinoin use for the treatment of severe acne in young patients. To the best of our knowledge, this is the first described case of renal thromboembolism and DCM requiring S-ICD implantation and cardiac transplant program listing occurring in the course of isotretinoin treatment.
Abstract 270: Eligibility Of Out-of-hospital Cardiac Arrest Patients For Extracorporeal Cardiopulmonary Resuscitation In The United States: A Geographic Information System Model
Authors: Adam L Gottula, Christopher shaw, Kari Gorder, Bennett Lane, Jennifer Latessa, Man Qi, Amy Koshoffer, Rabab Al-Araji, Wesley Young, Jordan Bonomo, James R Langabeer, Demetris Yannopoulos, Cindy H Hsu, Timothy D Henry, Justin L Benoit, CARES Surveillance Group .
Journal: Circulation (2022)

Introduction: Recent evidence suggest that ECPR may improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). Eligibility criteria for ECPR are often based on patient age, clinical variables, and facility capabilities. Expanding access to ECPR across the U.S. requires a better understanding of how these factors interact with transport time to ECPR centers. Methods: We constructed a Geographic Information System (GIS) model to estimate the number of ECPR candidates in the U.S. We utilized a Resuscitation Outcome Consortium (ROC) database to model time-dependent rates of ECPR eligibility and the Cardiac Arrest Registry to Enhance Survival (CARES) registry to determine the total number of OHCA patients who meet pre-specified ECPR criteria within designated transportation times. Potential ECPR centers were categorized as Extracorporeal Membrane Oxygenation (ECMO)-ready, ECMO-capable, or percutaneous coronary intervention (PCI)-capable centers using data from the Extracorporeal Life Support Organization and the American Hospital Directory. The combined model was used to estimate the total ECPR candidates and the effects of patient and hospital factors on ECPR eligibility. Results: There were 588,203 OHCA patients in the CARES registry from 2013 to 2020. After applying clinical eligibility criteria, 22,104 (3.76%) OHCA patients were eligible for ECPR. The rate of ROSC increased with longer resuscitation time, which resulted in fewer ECPR candidates. The proportion of OHCA patients eligible for ECPR increased with older age cutoffs. Only 1.68% (9,889/588,203) of OHCA patients in the U.S. were eligible for ECPR based on a 45-minute transportation time to an ECMO-ready center model, representing the current state of ECPR in the U.S. The proportion of OHCA patients eligible for ECPR ranged from 0.68% (4,027 patients in the 15-minute transportation time to ECMO-ready center model) to 2.81% (16,558 patients in the 45-minute transportation time to PCI-capable center model). Conclusions: Less than 2% of OHCA patients are eligible for ECPR in the U.S. GIS models can identify the impact of clinical criteria, transportation time, and hospital capabilities on ECPR eligibility to inform future implementation strategies.